Q&A: Nurturing the human side of medical care

Nearly 20 years ago, Arnold P. Gold, MD, a pediatric neurologist, and his wife, Sandra
O. Gold, EdD, a psychologist, created the Arnold P. Gold Foundation to foster the
humanistic side of medical education. The Foundation has encouraged schools to establish
a ceremony in which new medical students are given a white coat and encouraged to
become caring physicians from their first days of medical school. Almost all U.S.
medical schools participate in the ceremony.

Jordan J. Cohen, MACP. Photo courtesy of the Gold Foundation.

Last year, Jordan J. Cohen, MACP, became chairman of the Gold Foundation. Despite
the current climate that tends to impede a close doctor-patient relationship, Dr.
Cohen believes that the Arnold P. Gold Foundation can help nurture humanism in medical
students and newly minted doctors. He talked to ACP Hospitalist about why some physicians have lost their personal connection with patients, and why
he believes that creating humanistic physicians is so important.

Q: What are some of the barriers that could impede medical students and residents from
becoming caring doctors?

A: There are many barriers. First of all, the seduction of new technology is so captivating,
so appealing, that there is a perception that that's what medicine is: just a matter
of getting the right answer and doing the right thing. That is a superficial view
of what the fundamental values of medicine are all about. We have become so enamored
of the technology that we tend to forget the basic commitment the physicians must
have to the patient-doctor relationship.

The commercialism that's so common in medicine now also is a barrier to these core
values. Medicine is viewed by many outside the profession and, unfortunately, by many
inside the profession as just another business. There is a tendency to view interactions
between doctor and patient [as] analogous to a vendor and a customer, rather than
a doctor and a patient receiving compassionate care. Commercialism is an ethic that
is fundamentally at odds with the profession.

Q: Do you feel like this shortcoming is changing with the work that the Foundation is
doing?

A: The Foundation has been remarkably successful in a fairly short period of time with
very limited resources. It's my impression that the tide is shifting, and there is
much more awareness and attention being paid to the caring aspects of our profession
as well as to the obvious importance of technical and skill-based issues. We are making
progress, and I am very proud of what the Foundation has been able to contribute to
that change.

Q: What do you think are the most significant ways that the Foundation has contributed?

A: The vast majority of medical schools now have some form of the white-coat ceremony,
which is the signature program of the Foundation and the first thing that [it] promoted.
A relatively new and potentially the most durable of our programs is the Gold Humanism
Honor Society. About 70 medical schools in the country have an honor society. It is
our hope and expectation that each one will become a local change agent for their
institution by exemplifying the importance of humanism in medicine.

Not only do the honor societies recognize and provide appropriate visibility to those
students selected by their peers for their especially noteworthy qualities of professionalism
and humanism, but the expectation is that these individuals, plus selected residents
and faculty, will create programs that are specific to their institutions. Be they
community action programs, ethics lectures or other kinds of activities, these programs
can enliven the commitment to humanism and professionalism in their respective schools.
Over the long run, this may well become the most important initiative that the Foundation
supports.

Q: How does your previous role as president of the Association of American Medical Colleges
influence the current work you are doing for the Gold Foundation?

A: Well, as president of the AAMC, I had the privilege of seeing the Association take
strong positions in support of professionalism and humanism in medical education.
I tried to do a number of things to underscore these values, and so it was a natural
transition from those experiences to trying to do something about the issues that
the Gold Foundation is pursuing.

Q: Do you think that the lack of humanism is generational? In other words, as Generation
X doctors replace baby boomers, could the pendulum swing back the other way?

A: Students who are attracted to medicine today are among the most idealistic I've ever
seen. So, I am very hopeful about that generational change. The worry is that their
acculturation to medicine often sends a different signal. The idealism that many bring
to medical school, rather than being reinforced, tends to wither. The goal of the
Gold Foundation is to underscore the importance of developing a professional view,
and recognizing the innate capacity and inclination of students to be humanistic professionally
... to reinforce that, develop it, honor it. [The goal is] to strengthen students'
willingness and ability to maintain those attitudes throughout their careers.

Q: Can you point to some medical reasons why having a humanistic doctor is important?

A: When patients and [the] public in general are polled about what they want in their
physicians, they articulate issues such as communication, spending time with them
and trying to understand them as human beings. It has also been well established that
patients who have a good relationship with their physicians are more compliant with
medical advice and do better as a result. There is a connection between physicians
who are committed to this kind of approach to the doctor-patient relationship and
how their patients experience interactions with health care providers.

Q: Despite the pressure on office-based physicians to see many patients, is it still
possible for them to reach out in a human, emotional way?

A: There's no question that physicians in practice today have many demands on their time.
They are obliged to see more patients and to shorten the time that they have with
each, but I don't think that's a justification for abandoning our core principles.
As Francis Weld Peabody famously said a century ago, the key to the care of patients
is caring for the patient.

Sarah Pressman Lovinger, ACP Member, is a freelance medical reporter based in Evanson,
Ill., and a general internist who practices part-time in Chicago.

ACP Hospitalist provides news and information for hospitalists, covering the major issues in the field. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated.